Verified by 
So often cancer patients and their families enter a world that’s overwhelming. For starters, the word cancer evokes fear and anxiety, and especially in the older population, a sense of hopelessness. Because cancer is an avoided topic for many, especially in the elderly, ignorance about control and/or cure is commonplace. Today, we actually do cure a lot of people, and especially in early stage cancer, the cure rates can be dramatic. In the elderly, however, there is still a lingering pessimism, which is in part related to avoidance of information.
It hadn’t been so long since suspicion, secrecy, concealment and misinformation were the norm relative to cancer. Cancer was often thought of with revulsion, embarrassment, and often, the disease was hidden from family and friends. Earlier generations were very private about their medical issues, especially with breast and other female tumors. Frequently paternalistic physicians compounded things in this and other diseases, by fostering the attitude that patients were best left in the dark, and shielded from hard facts. My wife’s grandmother, for example, hid from everyone that she had breast cancer. Two years passed before the advanced stage precluded further secrecy. This behavior was not rare in that generation. Fortunately this has changed, partially because of two notable women who went public with their own breast cancers – Ambassador Shirley Temple Black and First Lady Betty Ford were both driving forces in promoting openness. Since, patient information, self–advocacy, and substantive discussion between doctors and patients have become the norm. As the younger generations advance in the environment of full disclosure, patient awareness and autonomy, secretiveness will hopefully become a thing of the past. This newfound attitude has already translated into improved cancer cure numbers.
Patient knowledge and awareness is based on several things, including intelligent dialogue with one’s doctor, and an increasing public technologic competence that allows information retrieval from the Internet; however, for contemporary patients to take advantage of these facts, they must wade through a vocabulary that has historically mystified lay people. That’s not to say that this “medical language” is inappropriate, merely that it shouldn’t be proprietary. My goal in this writing is to demystify some of the lingo, and make it more understandable for the readership. As future blogs are written, I will discuss a variety of these issues as I delve into the whole subject of patient comprehension, as well as physician’s communicative skills (or lack of). More later. For now, the following are some of common terms used in cancer discussions:
Malignant (a malignancy) is a new growth that has the capacity for spread to different sites in the body. In addition to this spread, it can destroy adjacent tissues, as well as the host organ.
Benign means a new growth that is non-malignancy. A growth that is non-malignant does not have the capacity to spread to other sites, but it can grow and destroy locally – pushing aside what is adjacent, and in that capacity, can be harmful.
Cancer is the formal name for malignancy. The two words are synonymous.
Tumor is the general word for a growth, either benign or malignant. A common example is a polyp, which can be benign or malignant.
Mass is a non-specific term denoting a lump or bump. For example a pimple or an abscess can be referred to as a mass. A breast mass could be a tumor (benign or malignant), a cyst, or even scar tissue. The word raises fear, but in itself does not have an ominous connotation.
Carcinoma is a cancer that originates in the surface tissue of the body, such as the squamous cells of the skin, or other surfaces. In such cases, it would be called a squamous cell carcinoma. A carcinoma that originates in the glandular cells that line certain structures such as the salivary glands, the pancreas, or the intestinal tract are called an adenocarcinomas. Carcinomas are always malignant.
Sarcoma is a cancer that originates in the connective tissues of the body, such as muscle, bone, fascia, and others. Sarcomas are always malignant.
Melanoma is a skin cancer that originates in the melanocyte, which is a particular cell within the skin architecture. They are always malignant.
Leukemia is a cancer originating in one of the blood cells, such as lymphocytes, or monocytes.
Lymphoma is a cancer that originates in the lymphoid tissue i.e., the lymphocytes.
Lesion is a non-specific term that can refer to any growth or mass, either benign or malignant.
Nodule is another non-specific term that generally refers to benign enlargements, although there is no assurance that it is so. It’s like saying “a bump”
Metastasis refers to spread of a cancer. Benign tumors do not metastasize. To metastasize is to use the verb of metastasis.
Distant metastasis refers to spread to another part of the body, such as lung, liver, or bone from a primary source such as oral cavity.
Regional metastasis is spread to the immediate area, such as oral cavity spreading to the glands in the neck.
Recurrence is the reappearance of a tumor that had disappeared after treatment.
Recrudescence is a non-specific word referring to re-growth of a tumor after dormancy, and although it is usually used in discussing cancers, can apply to benign tumors.
Margins refer to the edge of a tumor. Margins are often biopsied and studied under the microscope to determine if the tumor has been adequately circumvented by treatment – surgical excision or radiation. This word applies to malignant as well as benign.
Positive margins represent the state when there is evidence of tumor cells in the edge of the treatment site.
Control is used with cancer after treatment, and does not necessarily indicate cure.
Cure is the term used when there is no evidence of tumor after a prescribed time frame. This varies with different tumors.
Five-Year Survival is an arbitrary time of disease freedom that is generally used for statistical analysis. Some cancers can recur well after this, although five years is a good benchmark.
Oncology is a word that denotes the study of tumors, malignant as well as benign. Those doctors responsible for the evaluation and management of these patients are referred to as oncologists. Oncology is subdivided into surgical, medical, radiation and pscho-oncology.
Surgical oncologists are further divided: urologic, gynecologic, orthopedic, neurologic, head and neck, dermatologic, colon-rectal, breast, and thoracic. All of these have in common the fact that they have undergone extra training (fellowship) after their basic surgical training, and also, each generally limits their practice to surgery of tumors (malignant and benign), in their respective areas. One other category, the general surgical oncologists has followed general surgical residency with one or two additional fellowship years in which the fellow rotates through all of the different disciplines listed above. These surgeons usually gravitate to one specific area once in practice, such as breast, colon-rectal, or others.
Medical oncologists are often referred to as chemotherapists. These individuals did their residency training in internal medicine, and went on to do post residency fellowships in medical oncology. Chemotherapy has become a casually and somewhat inaccurately used word. It can represent a variety of cytotoxic drugs, and in the strict definition of words, should not include other medical tools that are frequently used to fight cancer, such as immune modulators, gene therapy, hormonal therapy, and others. All of these medical treatments, including cytotoxic drugs fall within the domain of medical oncology; thus the preferred label for these doctors is medical oncologists, rather than chemotherapist.
Radiation oncology is synonymous with radiation therapy, and the individuals administering it are radiation oncologists, or radiation therapists. Patients sometimes mistakenly refer to these oncologists as radiologists. These latter doctors are diagnosticians, interpreting x-rays, various scans, and MRI (magnetic resonance imaging), and their training is drastically different from radiation oncologists.
Psycho-oncology is a relatively new branch of psychiatry, and consists of a limited number of doctors who deal mainly with and treat cancer victims and their families. Because of supply and demand, general psychiatrists care for most cancer patients who require help, even though they are not officially psycho-oncologists.
One last thing: with the exceptions of surgical and psycho-oncologists, oncologists refer to the effects of their management in terms of response -partial (PR) and complete (CR). These are different than cure. A PR refers to at least a 50 percent reduction in tumor volume following treatment, and a CR refers to disappearance of the tumor. Recurrence usually follows PR, but can occur following even a CR. We all use the word cure to denote lack of reappearance of the tumor after a certain time span, which varies with the different types of tumor.
Roy B. Sessions, MD, FACS
